Office of Citizen Complaints

Policy Recommendations

Second Quarter 1999
Reference: 98-0421, DM-12

SUBJECT: Booking and Detention, Prisoner Handling, Access to Medications

The Office of Citizen Complaints recommends that the San Francisco Police Department amend the Booking and Detention Manual and Department General Orders to require officers to

(1) provide a release form to confirm prescriptions of arrested persons indicating a need for time specific medications and to allow access to medications when a physician's confirmation is received or

(2) request immediate medical evaluation for such persons.

During the course of an arrest complainant informed officers that he is a permanently disabled person with AIDS and heart disease. He also informed officers that he was hungry and needed to take carefully timed antiretroviral medications. Complying with current Department policy, officers denied complainant access to his medications.

Importance of Medications:
Antiretroviral medications are effective HIV/AIDS management therapies. After a retrovirus (i.e., HIV) penetrates a cell, it constructs a DNA version of its genes. This DNA then becomes part of the cell's genetic material. Antiretroviral drugs work by interfering with this stage of the viral life cycle.

Management of Medications is Complex:
Therapy typically requires that a person take a dozen or more pills each day with specific timing and dietary requirements. Some drugs need to be taken with a meal, others within a specific time period before or after a meal; other drugs must be refrigerated. When a person also needs preventive or maintenance doses for opportunistic infections, the total daily pill count increases dramatically. Therefore, medication therapy can be difficult to manage, even under the best of circumstances.

Interruption of Medications Harms Patients:
It is widely accepted that interruption of antiretroviral medications is potentially dangerous for patients. The degree to which interruption is tolerable and how quickly it contributes to complications is not completely understood. What is clear is that if antiretroviral medications are not taken at scheduled intervals the potential benefits of the therapy are greatly diminished and drug resistance often develops. In addition, resistance to one therapy may result in decreased effectiveness of similar therapies and the narrowing or exhaustion of the person's treatment options.

Ease of Obtaining Release Form:
Most patients requiring antiretroviral medications are in close contact with their physicians, due in part to the fact that physicians must carefully assess the likelihood of the patient's adherence to the therapy. Therefore, confirmation of the specific medication and the need for ready access is easily obtained. The release form should be directed to a specific physician or medical facility and should limit the request to a list of current medications.

Case Investigated by: MARY E. IVAS, Investigator
Prepared by: RIVER GINCHILD ABEJE, Policy and Outreach Specialist
Approved by: MARY C. DUNLAP, Director
Date: June 21, 1999

References: Guidelines for the Use of Antiretroviral Agents in HIV-Infected Adults and Adolescents, Department of Health and Human Services, May 5, 1999. Adherence to HAART (Highly active antiretroviral therapy), Project Inform, June 1998. HIV/AIDS Treatment Information Service, Glossary of HIV/AIDS-Related Terms, March 1997.

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